Sat Nov 28, 2015 10:40 am
#1421085
Interesting question and topical conversation.
Essentially it is an ethical dilemma for the poor Doctor concerned. On one hand you have the patient/client's confidentiality and on the other hand the need to protect third parties and the public from unnecessary risks. When this dilemma occurs, it is up to the Doctor concerned to make a decision as to whether the later (the potential for risk to others) is so high as to outweigh the over-riding principle of patient confidentiality.
Speaking with my GP hat on, I can tell you I been in this position a number of times. Generally some serious symptom or condition has been identified (e.g blackouts with no warning, or a recent diagnosis of epilepsy are two examples). My usual policy is to then clearly advise the patient they need to stop driving and ask them to write to and inform the DVLA, copying me in so I can see they have done so and are acting to protect others. If the patient has an "attitude issue" and clearly appears to not want to accept the advice, or if they agree but then don't seem to inform the DVLA as they had agreed to do so, I then have to consider whether to breach confidentiality.
I usually discuss the case (without divulging patient details) with a colleague or my indemnifying organisation, because if I make the wrong decision, the GMC might want to investigate if or when the patient complains to them, and may even strike me off the register for having broken confidentiality. So it is quite a heavy decision to have to make. Once I, and my confidential counsel, agree there is no alternative action that can be taken other than to break the patient's confidentiality, I then write a carefully worded letter stating the facts, with only enough information to make clear what the issues are that appear to prevent the patient being considered safe to drive. I also send a copy of this to the patient with a covering letter explaining I have felt there was no choice but to take this action, and explaining why, with an appropriate apology but pointing out I have a duty to protect innocent third parties.
As an AME, I have only ever had one occasion that someone has failed their medical and the condition / symptoms were such that the patient was advised their HGV (Group 2) medical could be in jeopardy and in my opinion they should stop driving HGV's and inform the DVLA. As most sensible pilots and patients see sense, so did this one, and 3 days later I received a copy of the patient's letter to the DVLA. I was able to facilitate with the patient's consent and wrote their GP a letter to advise them of my concerns, and to try and help pave the way for the necessary tests required medically - from a health perspective.
I hope this provides an insight into the Doctor's position, no matter their job, and the difficulties and dangers involved in such decisions. I certainly know of one GP colleague who was investigated by the GMC following a patient complaint when he wrote to the DVLA with concerns about that patient. He had 4 months of stress, and worry, before he was vindicated of his actions. He told me after that he would never put his career on the line again vowed never to do that again. He has been retired a number of years now.
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